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Foam roller it’s over

For many runners the most intimate relationship they have outside of wedlock and with their masseuse is with a solid cylinder of foam. This foam roller is diligently rolled over by thousands of runners each day as a means to ease their diabolical suffering cause by iliotibial band syndrome.

Like most running remedies it hurts bad, but runners being the masochistic bunch we are, will endure such suffering to keep ourselves on the road and in within touching distance of our next big goal. ITB pain … I will ignore and run through this minor ailment! That is until it stops you running.

But you know what the problem with the foam roller is?It’s a treatment, not a cure and a pretty average remedy at that, because the composition and situation of the iliotibial band within the body makes it devilishly hard to massage and stretch to good effect. And worse, the next time you head out and run, your ITB sourced knee pain returns with a vengeance, perhaps not in the first mile or two, but as you push through thirty minutes of running it’s hello pain.

Your source of comfort? Foam roller, an unsympathetic and hurtful companion. Like a bad friend or destructive relationship of any kind, perhaps it’s time you broke up? Maybe you’re ready to say those words “foam roller it is over.”

So what causes ITB syndrome and that crippling knee pain?

Traditional thought would have it that the pain is caused by friction between the tough ITB and a bony protuberance on the outside of the knee. This may well be true, but in day to day business the ITB doesn’t act up unless there is something going on that causes it to tighten up or become inflamed – so all that foam rolling is just treating the symptoms not the cause. The reason your ITB is inflamed is because of the way you run.

As I’ve covered in a previous post about the running injury equation, most running injuries are overuse type afflictions. This generally comes about by either overusing the muscle in a role it’s not designed for, or overstretching it because your body has inherent weakness or instability that pushes the impacted area outside its normal range of motion.

I don’t know in what proportion ITB pain is caused by overuse or by overstretch and it doesn’t really matter, because the two in this case are so closely interrelated that you attack this injury as if both are playing a role in causing your pain – and they probably do, here’s why:

ITB pain caused by overuse of the TFL

ITB pain and iliotiobal band syndrome has been commonly linked to over activity in the TFL (Tensor Fascia Lata) muscle or the Late muscle as it’s otherwise known in coffee drinking circles. The TFL in running plays a role in helping retrieve the leg from behind the body (through pre-stretch) and then send it forwards into hip flexion (knees ahead of the body). Many runners trigger the leg retrieval and hip fexion impulse too early because their glutes and hamstrings are not strong enough to give you a decent hip extension and pop forwards into the next stride.

How do I know this? I used to run this way and in the coaching work I have been doing throughout this year it has been a consistent pattern again and again, especially among recreational runners. For those of you who’ve yet to sit through the misfortune of looking at my old running technique, here we go again. Note: some of that purposeful thrusting forwards is coming via the TFL.

Overusing the TFL, which is a relatively small muscle, to help try and thrust the leg forwards too much and from an unfavorable position is bound to cause you problems. Soon enough the muscle will become tight and therefore this has a good chance of impacting, via its attachment, the ITB. Remedy:more power from the buttocks, enabling you to complete hip extension, will mean it’s much less necessary to carry and thrust your leg forwards to create stride length.

ITB pain caused by overstretch through internal rotation of the thigh

Runners that don’t have the strength or control over their glute max and the entire buttocks complex can allow the thigh to rotate inwards, because there is insufficient power being applied or resistance being given from the hip abductors and external rotators (your butt). The knee collapses inwards and the ITB is over stretched with every stride.

The shape of the glute max gives you the clue, those fibers are wrapping around the hip from side to back, they help you extend the hip, but also provide the external rotation impulse that keeps the thigh in proper alignment with the hip and not collapsing inwards. If you want to go to school on running and how important I think glute max is to the process you can check out my book for a lot more analysis of how the bum works in running.

Example of thigh rotating inwards on contact

Sorry, you’ll have to look at me again. I’m not sure why I’m covered in so much black marker, but it does serve to highlight some of the instability I’ve written about in this article.

ITB pain from walking – what does this tell us about our running?

Two of the worst bouts of ITB pain that I have experienced were brought on by sustained periods of walking. I walked as I used to run, all quads and hip flexors, no bum or hamstrings. Combining all the elements we’ve just covered, overusing the TFL and collapsing through the hips. One reason why so many runners struggle with ITB pain is the startling similarity (in terms of muscle activation patterns) between their running technique and their walking gait. If you do as I did, which was to maintain the same pattern, but just speed it up when you’re running, you’re asking for trouble.

The facts: how to cure ITB syndrome – strength training

So setting aside my own theories about how you ended up with an ITB injury, there is little doubting the research I came across when putting my book together. A number of studies have shown that improving hip abductor and external rotator strength and activation can resolve ITB injuries. So you don’t even need to be a big believer in working on running form, you just need to get stronger around the buttocks.

Are my hips too weak to run without getting hurt?

If you can’t stand on one leg with your knee very slightly flexed without your knee cap dipping inside the line of your big toe, then you need to strengthen and learn to activate your buttock muscles. If you don’t do this there is a greater risk of injuries developing down the track.

Find out how to be the first of your running buddies to break up with your foam roller by reading these articles below and/or visiting the strength training program:

15 Responses to Foam roller it’s over

I have been trying everything, looking all over the internet, for my ITB / runners knee. I just got a foam roller too! LOL. This is by far the best site, with the best information, that I have seen. No one else talks about the mechanics — they just say “strengthen hip abductors” or something and that’s it. Not very helpful. Now I know the mechanics of this malady — and it all makes sense together given my particular gait and strengths and weaknesses!!! Lunges would help – as would stretching my hip flexors and not prematurely kicking my leg forward (which I do a LOT) and instead letting the stretch-back pop it forward! I also had pain in the TFL and where the TFL / ITB attaches to the illiac crest on the hip! Now I have pain down on the other end by the knee. MAKES PERFECT SENSE. I have seen a video of my gait… and the main thing I notice is that my leg does not go back very far — and a coach has told me my most limited / tightest part of my flexibility is my HIP FLEXORS!!! I had practically a religious experience here today — I saw the light as it all came together! Now it is OBVIOUS what I need to do — with strengthening, stretching, gait changes… WOW, just WOW. FANTASTIC SITE!

Thanks very much for the feedback Steven, yes getting stronger through the posterior is key to resolving ITB issues. Take your time implementing the changes, a steady approach over 12 weeks is the way to go. Let me know how you get on.

Hello Brian. I’ve just stumbled across your information while looking up ITB pain. I’m hoping to put some of your suggestions into action. I’ve been running for 20years injury free….so this is very new for me. I am presently seeing a physiotherapist as well as an Osteopath. It’s helping some what but I think some of your suggestions will help as well. I really had no idea how not running would affect me. My girls think the sooner I get ack to it, the more peaceful their lives will become. I guess I just need to hear that this is something that I can get through and return to what I love to do best….RUNNING!!!
Thanks,
Lynda

Hi Lynda, yes you can definitely get through this – some treatment in the acute phase is helpful but long term getting stuck into the hip strength and stability work as been shown to produce good results that will help prevent any occurrence. Brian

I’ve a teenage son who suffers badly! Sometimes he crawls to the bathroom in pain … sometime it’s not so bad … he had physio therapy but it didn’t make the problem go away …. He was said to have ITB Syndrome by some Doctors … some believe, some don’t – mixed reactions by some professions. We are in the process of trying different footwear so see how it goes.

Hi Sam, sorry to hear about your son’s problem. If he’s crawling in pain the injury sounds relatively serious – getting a few different opinions from different sports doctors and physios would be a good idea. Once you have the problem properly diagnosed then thinking about rehabilitation and strengthening exercises under supervision from a professional would be the next step. Different shoes may help, but are unlikely to be the whole solution. Your doing the right thing, keep asking for different opinions until you’re satisfied the injury is diagnosed correctly. Brian

Very interesting article. I have battled ITB on and off for my entire running career; Although my foam roller has been a godsend, it is nice to know that with enough glute, hamstring and external rotator strength, I can break up with it.

Interesting stuff. I have fitted about 1500 runners for shoes. I would always ask them if they have ITB issues or medial shin splints. Most of the time the cause of ITB has been using Stability shoes, when they don’t actually need them. The runners had either bought the shoes on their own (not professionally fitted), or been mis-fitted by ignorant “fit experts” (unfortunately, this even included my co-workers).

This happened to one of my own runners, a marathoner, who has a fairly well-balanced training program. He was fitted into the Mizuno Inspire by a co-worker of mine, then suddenly developed ITB problems. I had my runner come in while I was working so that I could assess him myself, and I was both dismayed and relieved to see that he had a more Neutral gait and did not need Stability shoes. He is now running injury-free in the Nike Vomero, a Neutral shoe.

My perception, based upon 1500 fittings:
The medial post in Stability shoes effectively tips the leg slightly outward, also prompting the runner to plant his foot closer to his centerline (to offset the post). For heel-striking runners who significantly collapse inward, this is often helpful, especially since I think they often, due to the flexing, step too far to the outside of their hips.

…but for heel-striking runners who don’t significantly flex inward, and don’t step too far to the outside (and may even step too close to the centerline), nor need stability shoes, this ends up slightly stretching everything on the outside of the leg, including the ITB. Some people even get tired and sore on the outsides of their ankles. Stability shoes can cause major ITB problems among neutral runners.

Danger is especially elevated among neutral runners whose form is so bad that they are using the cushioning of the shoes (especially the heels) as “crutches”. I think many runners are better off heel-striking than fore/mid-foot striking, but it still needs to be done via good force vectors.

G’day Jimmy, thanks for the feedback and comment. I think the idea that the medial post encourages runners to land centrally is an interesting one. I do believe that is does allow runners to become a bit lazy and not activate the buttocks as much as they should. Strength work and some coaching around early activation of the glutes and hamstrings can help bring things back into good alignment without the use of stability shoes. Brian

Yeah, I would highly recommend, if people are going to be wearing shoes during a gait analysis for anything other than shoe fitting, that they make sure they have the proper type of shoes beforehand. Otherwise, this can skew everything. Other options include going barefoot or using minimalist/racing shoes, to reduce unnatural forces and ensure a more sterile environment. Regular neutral trainers *might* be ok.

Personally I prefer to first watch the person go barefoot so I can see what the runner does by him/herself, *and* then in a properly-fitting function of shoe.